Pancreatitis aguda 2016
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Transcript of Pancreatitis aguda 2016
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ESPECIALISTA EN CIRUGÍA GENERAL UNIVERSIDAD METROPOLITANA
HUFT
DR. LIBARDO MUÑOZ M
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ENFERMEDADES PANCREATICAS
Pancreatitis aguda
Pancreatitis Crónica
Cáncer pancreático
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PANCREATITIS AGUDA
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PANCREAS
Retroperitoneal exceptuando la colaMide 12 a 15 cm y pesa 70 a 100 grParte caudal del intestino anterior ( botones
pancreáticos dorsal y ventral)Secreción exocrina va los conductos
pancreáticos90% de los casos los conductos se unen en la
cabeza y el 10% separados
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PANCREAS
Irrigación deriva del tronco celiaco y arteria mesentérica superior
Arterias pancreaticoduodenales superior anterior y posterior ---- arteria gastroduodenal
Arterias pancreaticoduodenales inferior anterior y posterior ------arteria mesentérica superior
Ramas de la arteria esplénicaDrenaje venosos termina en la vena porta
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PANCREAS
Drenaje linfático superior a ganglios subpiloricos de la arteria hepática , hilio esplénico y ligamento esplenodiafragmatico
Inervación visceral eferente se da por nervios vago y asplácnicos por vía de los plexos hepático y celiaco
Fibras posganglionares inervan acinos, islotes y conductos
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PANCREAS
EXOCRINO : 80% del órgano. Formada por acinos. La terminal del citoplasma de estas células contienen gránulos de zimógenos
ENDOCRINO: 20%. (islotes de Langerhans). Insulina, glucagón, polipéptido pancreático y somatostatina
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PANCREATITIS AGUDA
1992 simposio mundial en Atlanta, Georgia
Proceso inflamatorio agudo del páncreas que se acompaña de un compromiso variable de otros tejidos regionales u órganos o sistemas lejanos
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PANCREATITIS AGUDA
Clasificación en simposio de 1992
1. moderada
2. severa
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Pancreatitis moderada: condición asociada con mínimo compromiso orgánico y recuperación parcial o completa
Pancreatitis severa: cuando hay evidencia de falla orgánica o complicaciones locales como necrosis, abscesos o pseudoquistes
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Signos pronósticos tempranos desfavorable en la pancreatitis severa : 3 criterios de Ranson 8 puntos de apache
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Necrosis pancreática : se presenta en el 20% de los pacientes , se asocia con necrosis grasa
Necrosis estéril infectadaColección aguda pancreática : ocurre
temprano, esta en el páncreas o fuera de él ocurre en 30 a 50% de pacientes.
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Pseudoquistes : colección de jugo pancreático, rodeada por pared de tejido fibroso o de granulación
Absceso pancreático : colección de pus
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ETIOLOGIA
Teoría del canal común: coledocolitiasisAlcohol : consumo diario de 158 gr/día Hiperparatiroidismo: 10,5%HereditariaHiperlipoproteinemiaMedicamentosCPRETraumática
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FISIOPATOLOGIA
Lesión inicial ocurre dentro de la célula acinar
Enzimas pancreáticas salen al intersticio causando edema y posiblemente inflamación
Lipasa y la colipasa también salen y producen necrosis grasa peri pancreática
Insuficiencia vascular y radicales libres de O2Neutrófilos, macrófagos, monocitos, linfocitos
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FISIOPATOLOGIA
InflamaciónEstimulo de leucos es excesivo y aparece
amplia liberación de mediadores inflamatorios
Mediadores liberados por neutrófilos, macrófagos y monocitos destructivos(elastasa, fosfolipasa A2, factor activador de plaquetas, citoquinas, y O2
Factor de necrosis tumoral: ruptura de capilar y generación de fiebre
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MANIFESTACIONES CLINICA
Dolor Distensión abdominalNauseas y vómitosIctericiaFrialdad, sudoración, deshidrataciónTaquicardia, taquipnea
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DIAGNOSTICO
HemoleucogramaAmilasa: urinariaLipasaBilirrubinasÍndice de levit: amilasa u x creatinina s x 100
amilasa s creatinina u
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IMAGENOLOGIA
Ecografía abdominal
Rx de abdomen
TAC de abdomen contrastado
Resonancia magnética de abdomen
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CRITERIOS PRONOSTICO DE RANSON
Pancreatitis no biliar Ingreso Edad >55 años Leucocitos >16.000 mm3 Glucosa >200 mg/dl LDH >350 U/l GOT >250 U/l 48 horas de hospitalización Caída Hto >10 % Urea >5 mg/dl Calcio sérico <8 mg/dl paO2 <60 mm Hg Déficit base >4 mmol/l Déficit volumen >6 l
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Evaluación de la severidad en PA
Leve Grave
Ranson < 3 Puntos > 3 PuntosAPACHE II < 8 Puntos > 8 PuntosGlasgow < 3 Puntos > 3 PuntosOsborne < 3 Puntos > 3 PuntosDéficit de base Valor > 0 Valor < 0Calcio sérico >7.5 mg/dl < 7.5 mg/dlHematocrito < 47 > 47Criterios tomográficosde Balthazar < Grado D > Grado D
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